Emergency medical services (EMS) responders, as well as all other responders, must have the personal protective equipment and the proper technological tools they need to help the victims of a disaster without harming themselves in the process. That obvious requirement is especially important during response operations to an RDD (radiological dispersal device) event when victims might not only be injured by the explosion but also could be covered with radiological material that, without the appropriate equipment, might be impossible to detect. In short, medical responders rushing to help RDD victims must have access to and training on technological systems to keep themselves and the incident victims safe.
In 2002, the City of Baltimore purchased personal “alarming” dosimeters for its fire, police, and EMS responders and vehicles. Dosimeters detect the ambient exposure rate of responders. The city chose a dosimeter that was both slim and lightweight and fitted with an easy-to-read numerical display. However, after using the devices for a short period of time, responders found several problems that the city had not considered. For example, because of its thin design, the dosimeter required a specialized battery that could not be easily replaced on short notice. In addition, the battery case was difficult to open, and responders soon found that enabling the numeric display caused the battery to drain quickly. Because they could not keep the device’s battery easily charged, many responders simply stopped using the devices entirely.
The obvious lesson learned from the Baltimore experience is that, when purchasing dosimeters – or any other technological device or equipment item – for responders, the governing jurisdiction must take many functional requirements into account. Fortunately, the Federal Emergency Management Agency’s Responder Knowledge Base provides purchasers with product reviews and other information that could help them make important decisions on what types of equipment would probably be most useful.
Twisted Rails, Clear Thinking, and Proper Training It is not enough, of course, to provide medical responders with the best and most useful equipment; the responders themselves must be trained on how to use the equipment. During the 2006 Southeast Transportation Corridor “Pilot Technology Demonstration” exercise – sponsored by the Department of Homeland Security’s Domestic Nuclear Detection Office – participants used both fixed and portable radiation detection equipment to scan incoming cargo at various port-security and vehicle-weighing stations. The working hypothesis was that, if any radiological material could be stopped at these points of entry, the responders participating may well have prevented a radiological attack.
During the exercise, which involved participants from the federal level as well as several states, most radiological material was in fact successfully detected and removed as a potential threat. However, in some cases, participants did not detect (and then remove) potential hazards because they had not been properly trained on the detection equipment they were using. More specifically: Because responders did not understand how to interpret the detection results, some radiological material was in fact allowed to pass through. Here the lesson learned was that the jurisdictions responsible should provide sufficient equipment training to the personnel likely to be responsible for the detection of radiological materials.
If an RDD event were to occur today anywhere in the United States, responders would have to be especially concerned with unnecessarily spreading radiological material throughout uncontaminated areas. The best way to ensure the safety of the surrounding area is to decontaminate everything before it leaves the contaminated scene. During the 2005 “Twisted Rail” full-scale exercise – sponsored by the Westmoreland County (Pa.) Department of Public Safety – close to 300 participants from all levels of government worked together to decontaminate the victims of a simulated train explosion that had released dangerous (but also simulated) chemical agents.
The decontamination procedures postulated were correctly followed, but the hazmat (hazardous materials) team did not screen victims after their decontamination to ensure that all potentially hazardous materials had been removed. Many of the victims were immediately loaded into EMS vehicles, for example, and driven with responders to area medical facilities. If any of those victims had still been contaminated, the hazard posed by the chemical agents might have spread considerably, endangering all of the emergency medical responders who had come into contact with those agents. In incidents where there is a need for mass decontamination, responders should station a hazmat staff member – who has received the appropriate equipment training needed – at the exit of the decontamination area to carry out a “final scan” on the victims being evacuated.
The “Arrival Rule”: Scan Before Admitting If any of the participants in the Twisted Rail exercise had carried hazardous material into the emergency vehicle, the hospital where that person was taken should have been able to detect the threat and decontaminate him or her upon arrival – before admitting the patient to the hospital, it should be emphasized. In 2005, the State of Oregon tested its ability to respond to a radiological IED (improvised explosive device) as part of a functional exercise in Hood River County. During that exercise, some victims became contaminated and/or were injured in other ways by the initial blast; others became contaminated when they rushed into the incident scene to help the first victims.
Concerned that some victims, unaware of the contamination threat, had already transported themselves to area hospitals, the incident commander instructed the hospitals to scan patients as they entered and were seeking admission. However, some hospital staff members did not have the proper equipment and/or the training needed to scan each and every person who arrived at the hospital seeking admission. The result was that some patients were in fact allowed to access the facility without being decontaminated.
If the radiological IED incident had been real rather than simulated, the admission of those contaminated victims would have caused many other people, equipment items, and working areas in the hospital to also become contaminated. Instead of purchasing additional personal radiological detection equipment – and training more staff members on how to use that equipment – hospitals might consider positioning relatively low-cost portable detection instruments at key “traffic points” in the hospital – entrances and lobbies, for example. Doing so could ensure that every person who enters the hospital is scanned for radiological contamination.
To briefly summarize: All responders must have access to and be properly trained on the use of safety equipment, such as radiological detection devices. This technology is especially important to emergency medical providers, who not only have direct contact with victims immediately after an incident but also, in most situations, are responsible for safely transporting them to a medical facility where they can receive additional assistance.
Jennifer Smither is the outreach and operations manager for Lessons Learned Information Sharing (LLIS.gov), the Department of Homeland Security/Federal Emergency Management Agency’s national online network of lessons learned, best practices, and innovativeeas for the U.S. homeland security and emergency management communities. She received her bachelor’s degree in English from Florida State University.